Funding Woes Curb Childhood Vaccination Efforts

ObjectiveThe objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.DesignOur study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa.ParticipantsA total of 60 964 mothers of children aged 11–23 months were included in the study.Outcome variablesThe main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC).ResultsThe average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended.ConclusionThe study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.

Download Full-text

Childhood vaccination coverage in Australia: an equity perspective

BMC Public Health ◽

10.1186/s12889-021-11345-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arzu Arat ◽

Hannah C. Moore ◽

Sharon Goldfeld ◽

Viveca Östberg ◽

Vicky Sheppeard ◽

...

Keyword(s):

Vaccination Coverage ◽

Economic Status ◽

Childhood Vaccination ◽

High Coverage ◽

Socio Economic Status ◽

Policy Interventions ◽

South Wales ◽

Social Inequities ◽

Future Policy ◽

Aboriginal Children

Abstract Background This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured at age 24 months by maternal country of birth, Aboriginal status, maternal age at delivery, socio-economic status, and remoteness in two states. Results Vaccination coverage was 3–4% points lower among children of mothers who gave birth before the age of 20 years, mothers born overseas, mothers with an Aboriginal background, and parents with a low socio-economic status compared to children that did not belong to these social groups. In both states, between 2007 and 2011 there was a decline of 2.1% points in MMR1 vaccination coverage for children whose mothers were born overseas. In 2011, WA had lower coverage among the Aboriginal population (89.5%) and children of young mothers (89.3%) compared to NSW (92.2 and 92.1% respectively). Conclusion Despite overall high coverage of MMR1 vaccination, coverage inequalities increased especially for children of mothers born overseas. Strategic immunisation plans and policy interventions are important for equitable vaccination levels. Future policy should target children of mothers born overseas and Aboriginal children.

Download Full-text

1.C. Workshop: How are digital solutions contributing to enhance immunization programmes and policies?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.005 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Conceptual Framework ◽

World Health Organization ◽

Local Level ◽

Vaccine Uptake ◽

Childhood Vaccination ◽

World Health ◽

Vaccine Hesitancy ◽

The World ◽

Health Organization ◽

Immunization Programmes

Abstract As vaccine hesitancy and decreasing immunization coverage have been identified by the World Health Organization as global alarming health threats, it is of crucial importance to exploit the potential offered by digital solutions to enhance immunization programmes and ultimately increase vaccine uptake. We have previously developed and published a conceptual framework outlining how digitalization can support immunization at different levels: i) when adopted for health education and communication purposes, ii) in the context of immunization programmes delivery, and iii) in the context of immunization information systems management. The proposed workshop is co-organized by the EUPHA Digital health section (EUPHA-DH) and EUPHA Infectious diseases control section (EUPHA-IDC) and aims at discussing the current AVAILABILITY, USE and IMPACT of digital solutions to support immunization programmes at the international, national and local level, as well as, debating on how technical infrastructures on one side and normative and policy frameworks on the other side enable their implementation. We plan to have a rich set of contributions covering the following: the presentation of a conceptual framework identifying and mapping the digital solutions' features having the potential to bolster immunization programmes, namely: i) Personalization and precision; ii) Automation; iii) Prediction; iv) Data analytics (including big data and interoperability); and v) Interaction; the dissemination of key results and final outputs of a Europe-wide funded project on the use of Information & Communication Technology to enhance immunization, with particular reference to the use and comparative impact of email remainders and personal electronic health records, as well as the results of an international survey conducted to map and collect best practices on the use of different digital solutions within immunization programmes at the national and regional level; the firsthand experience of the United Kingdom NHS Digital Child Health Programme which developed, implemented and is currently evaluating a number of solutions to increase childhood vaccination uptake in England, including an information standard and information sharing services developed to ensure that the details of children's vaccinations can be shared between different health care settings the perspective and experience of the European Centre for Disease Prevention and Control (ECDC) for Europe and of the World Health Organization (WHO) for the global level of what has worked so far in the digitalization of immunization programmes around the world, what recommendations were developed and which barriers identified at the technical normative and policy level Key messages Digitalization has great potential to support immunization programmes but its practice and impact need to be measured. Country-level and international experiences have created qualitative and quantitative evidence on the effectiveness of digital intervention aimed at increasing vaccine uptake.

Download Full-text

87. Impact of State of Residence on Adult Vaccination Uptake: A Multilevel Modeling Approach

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.397 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S175-S175

Author(s):

Shannon Hunter ◽

Diana Garbinsky ◽

Elizabeth M La ◽

Sara Poston ◽

Cosmina Hogea

Keyword(s):

Multilevel Modeling ◽

Vaccination Coverage ◽

Multilevel Models ◽

State Level ◽

Childhood Vaccination ◽

Material Support ◽

Adult Vaccination ◽

Direct Compensation ◽

Cluster Variation ◽

Coverage Rates

Abstract Background Previous studies on adult vaccination coverage found inter-state variability that persists after adjusting for individual demographic factors. Assessing the impact of state-level factors may help improve uptake strategies. This study aimed to: • Update previous estimates of state-level, model-adjusted coverage rates for influenza; pneumococcal; tetanus, diphtheria, and acellular pertussis (Tdap); and herpes zoster (HZ) vaccines (individually and in compliance with all age-appropriate recommended vaccinations) • Evaluate effects of individual and state-level factors on adult vaccination coverage using a multilevel modeling framework. Methods Behavioral Risk Factor Surveillance System (BRFSS) survey data (2015–2017) were retrospectively analyzed. Multivariable logistic regression models estimated state vaccination coverage and compliance using predicted marginal proportions. BRFSS data were then combined with external state-level data to estimate multilevel models evaluating effects of state-level factors on coverage. Weighted odds ratios and measures of cluster variation were estimated. Results Adult vaccination coverage and compliance varied by state, even after adjusting for individual characteristics, with coverage ranging as follows: • Influenza (2017): 35.1–48.1% • Pneumococcal (2017): 68.2–80.8% • Tdap (2016): 21.9–46.5% • HZ (2017): 30.5–50.9% Few state-level variables were retained in final multilevel models, and measures of cluster variation suggested substantial residual variation unexplained by individual and state-level variables. Key state-level variables positively associated with vaccination included health insurance coverage rates (influenza/HZ), pharmacists’ vaccination authority (HZ), presence of childhood vaccination exemptions (pneumococcal/Tdap), and adult immunization information system participation (Tdap/HZ). Conclusion Adult vaccination coverage and compliance continue to show substantial variation by state even after adjusting for individual and state-level characteristics associated with vaccination. Further research is needed to assess additional state or local factors impacting vaccination disparities. Funding GlaxoSmithKline Biologicals SA (study identifier: HO-18-19794) Disclosures Shannon Hunter, MS, GSK (Other Financial or Material Support, Ms. Hunter is an employee of RTI Health Solutions, who received consultancy fees from GSK for conduct of the study. Ms. Hunter received no direct compensation from the Sponsor.) Diana Garbinsky, MS, GSK (Other Financial or Material Support, The study was conducted by RTI Health Solutions, which received consultancy fees from GSK. I am a salaried employee at RTI Health Solutions and received no direct compensation from GSK for the conduct of this study..) Elizabeth M. La, PhD, RTI Health Solutions (Employee) Sara Poston, PharmD, The GlaxoSmithKline group of companies (Employee, Shareholder) Cosmina Hogea, PhD, GlaxoSmithKline (Employee, Shareholder)

Download Full-text

Measles Exposure Investigation in a Children’s Hospital Emergency Department— Denver Metropolitan Area, Colorado, 2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.492 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s18-s19

Author(s):

Ashley Richter

Keyword(s):

Emergency Department ◽

International Travel ◽

Childhood Vaccination ◽

Prevention Measures ◽

Mmr Vaccine ◽

Children's Hospital ◽

Control Intervention ◽

Children’S Hospital ◽

Lost To Follow Up

Background: On December 14, 3 unvaccinated siblings with recent international travel presented to Children’s Hospital Colorado emergency department (CHCO-ED) with fever, rash, conjunctivitis, coryza, and cough. Measles was immediately suspected; respiratory masks were placed on the patients before they entered an airborne isolation room, and public health officials (PH) were promptly notified. Notably, on December 12, 1 ill sibling presented to CHCO-ED with fever only. We conducted an investigation to confirm measles, to determine susceptibility of potentially exposed ED contacts and healthcare workers (HCWs), and to implement infection prevention measures to prevent secondary cases. Methods: Measles was confirmed using polymerase chain reaction testing. Through medical record review and CHCO-ED unit-leader interviews, we identified patients and HCWs in overlapping ED areas with the first sibling, until 2 hours after discharge. Measles susceptibility was assessed through interviews with adults accompanying pediatric patients and HCW immunity record reviews. Potentially exposed persons were classified as immune (≥1 documented measles-mumps-rubella (MMR) vaccination or serologic evidence of immunity), unconfirmed immune (self-reported MMR or childhood vaccination without documentation), or susceptible (no MMR vaccine history or age <12 months). Susceptibility status directed disease control intervention, and contact follow-up was 21 days. Results: On December 14, all 3 siblings (ages 8–11 years) had laboratory-confirmed measles and were hospitalized. CHCO’s rapid isolation of the 3 cases within 5 minutes after presentation to the ED eliminated the need for exposure assessment on the day of hospitalization. However on December 12, the 1 ill sibling potentially exposed 258 ED contacts (90 patients, 168 accompanying adults) and 22 HCWs. The PH department identified 158 immune contacts (61%), 75 unconfirmed immune contacts (29%), and 19 susceptible contacts (8%); 6 contacts (2%) were lost to follow-up. Overall, 15 susceptible contacts received immune globulin (IG) postexposure prophylaxis and 4 contacts were placed on 21-day quarantine. Unconfirmed immune contacts self-monitored for measles symptoms and were contacted weekly by PH for 21 days. Moreover, 20 immune HCWs monitored symptoms daily; 2 susceptible HCWs were placed on 21-day quarantine. No secondary cases were identified. Conclusions: Rapid measles identification and isolation, high levels (90%) of immunity among contacts, prompt administration of IG, and effective collaboration between PH and CHCO prevented transmission.Funding: NoneDisclosures: None

Download Full-text